Weight loss surgery safe, beneficial: study

NEW YORK (Reuters Health) - Bariatric surgery results in
substantial weight loss and can turn back some diseases related
to obesity, a new study finds.

There is some risk of complications, but death rates appear
to be lower than previously thought, researchers reported after
reviewing about a decade's worth of recent data.

They were interested in updating current knowledge about the
effectiveness and safety of various types of weight loss
surgery, including gastric bypass, adjustable gastric banding
(lap banding), vertical banded gastroplasty and sleeve
gastrectomy.

These surgical procedures are used for people who are
severely obese, or moderately obese with serious weight-related
health problems. The last time there was a major update of
bariatric surgical research was in 2003.

"Previous reviews included data from clinical trials and
studies published before 2003, but because of advances in
technology of bariatric surgery and accumulation of surgeons'
experience, information provided in previous reviews is
outdated," Su-Hsin Chang told Reuters Health in an email.

Chang is an instructor with the Division of Public Health
Sciences, Department of Surgery at the Washington University
School of Medicine in St. Louis, Missouri and led the new study.

"We planned to answer general questions regarding
effectiveness and risks of surgical treatment of obesity and
which surgical procedure is the most efficacious," Chang said.

The results were published in JAMA Surgery.

The researchers reviewed 164 studies conducted from 2003 to
2012, which included a total of 161,756 patients. On average,
the patients were about 45 years old and almost 80 percent were
female.

The average body mass index (BMI), a measure of weight
relative to height, of patients before surgery was nearly 46. A
BMI of 18.5 to 24.9 is considered normal weight and a BMI of 35
or higher is considered obese.

Patients' presurgery weight averaged 274 pounds. More than a
quarter of patients had diabetes, nearly half had high blood
pressure and almost 30 percent had high cholesterol. Seven
percent had heart disease and 25 percent had sleep apnea.

Chang's group found that patients' BMI dropped by an average
of 12 to 17 points within 5 years after surgery. The researchers
also found that diabetes, high blood pressure and sleep apnea
improved significantly.

Between 86 percent and 92 percent of patients with diabetes
experienced remission of the disease. The same happened for
about 75 percent of those with high blood pressure.

High cholesterol and heart disease were rolled back at
slightly lower rates, but sleep apnea disappeared or improved
dramatically in more than 90 percent of those who had it
pre-surgery.

Death rates ranged from 0.08 within one month of surgery to
0.31 after 30 days. Complication rates ranged from 10 percent to
17 percent and the proportion of operations that needed to be
repeated was 6 percent to 7 percent.

Gastric bypass surgeries were the most effective in terms of
long-term weight loss, but the procedure had the highest
complication rates. Sleeve gastrectomy was almost as effective
as gastric bypass. Adjustable gastric bands (lap bands) weren't
quite as effective but were the safest.

"The article is very interesting and overdue," Dr. Pratt
Vemulapalli told Reuters Health in an email.

Vemulapalli is director of bariatric surgery and an
associate professor of surgery at the Montefiore Medical Center
of the University Hospital for the Albert Einstein College of
Medicine in New York. She was not involved in the study.

"Those of us doing bariatric surgery have seen this with our
own patients and in studies that have been published in the
literature but this meta-analysis simply ties that data together
and has wrapped the impression like a present in a neat
package," she said.

Vemulapalli said there are currently about 200,000 weight
loss procedures performed each year. She said the most common
procedures are the gastric bypass, the sleeve gastrectomy and,
to a lesser extent, the adjustable gastric band.

"The article itself was very well done, and shows that the
surgeons and centers who do surgery know how to do the
operations, know which patients to operate on and how to
identify and treat complications," she said, "All of this makes
for safer surgery."